Type of Facility/Specialty:
If you specified "other", please state the specialty:

Contact Person:Name of Facility
Address:
City:
State:
Zip:

Email Address:
Phone Number:

Are you currently dictating? Yes No
If yes, what type of recording sytem is being used?
Are you currently using a transcription service? Yes No
Projected Volume of dictation in lines or minutes per day: Minutes
Lines
Turnaround time needed?